Pathophysiology of Diabetes
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
Diabetes mellitus, diabetic ketoacidosis, and nonketotic hyperosmolar syndrome are the most common conditions linked to carbohydrate metabolism. Type 1 and type 2 diabetes are distinguished by various features. Impaired glucose regulation is related to impaired glucose tolerance or impaired fasting glucose. These strong risk factors for diabetes mellitus may be present for many years before the disease actually manifests. Diabetes is linked to higher risks for cardiovascular disease, but in most cases, common microvascular complications do not develop. In type 1 diabetes mellitus, there is insufficient insulin produced, due to autoimmune pancreatic beta cell destruction. This situation may be initiated by environmental factors, if an individual is genetically susceptible. The beta cells are continually destroyed over months or years, until their mass has decreased to a point at which insulin concentration can no longer control plasma levels of glucose. Type 1 diabetes most often develops in childhood or adolescence. In the past decades, it was the most common form of diabetes diagnosed in people younger than age 30. However, type 1 diabetes can also develop in adults, often seeming to be type 2 diabetes at first, and described as latent autoimmune diabetes of adulthood. In non-Caucasians, some cases of type 1 diabetes are idiopathic and do not apparently related to autoimmunity. It is not fully understood how beta cells are destroyed, but there are interactions between environmental factors, autoantigens, and susceptibility genes.
Diabetes basics
Erica Whettem in Nursing & Health Survival Guide, 2014
People who have higher than normal blood glucose levels but do not yet meet the criteria for a diagnosis of diabetes have impaired glucose regulation and are at increased risk of developing type 2 diabetes (p.3). Impaired fasting glucose is defined as a fasting venous plasma glucose of 6.1–6.9 mmol/L and (if measured) 2-hour post-glucose load of <7.8 mmol/LImpaired glucose tolerance is defined as a fasting blood glucose of <7.0 mmol/L but 2-hour level of 7.8–11.0 mmol/L (oral glucose tolerance test (p.7)).Evidence suggests intensive lifestyle (p.8) interventions can significantly delay the onset of diabetes in people with impaired glucose regulation.
Gestational diabetes
Nadia Barghouthi, Jessica Perini in Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
GDM greatly increases the risk of later development of type II DM by approximately 7-fold.36 This risk mandates ongoing assessment for type II DM after GDM.ADA and ACOG both recommend testing at 4–12 weeks postpartum with a fasting glucose and a 75-g OGTT in preference to HbA1c or fasting glucose alone.1,12 Positive results mandate treatment for diabetes.Women with impaired fasting glucose or impaired glucose tolerance have prediabetes and should be counseled regarding diet, exercise, and weight loss.12 Metformin can also be considered as first-line therapy.37Women with normal testing at 4–12 weeks postpartum still require indefinite follow-up, with ADA suggesting testing every 1–3 years using any ADA recommended glycemic test.12
Drug treatment strategies for secondary diabetes in patients with acromegaly
Published in Expert Opinion on Pharmacotherapy, 2020
Sylvère Störmann, Jochen Schopohl
The importance of diabetes in acromegaly is highlighted in an early and very short announcement from 1890 [15]: ‘Dr. Henry Alexis Thomson, of Edinburgh, describes, in the Journal of Anatomy and Physiology, a skeleton of a case of acromegaly. The patient was a man who died of diabetes at the age of 36.’ By the 1920 s several observations of diabetes in patients with acromegaly had been published and first estimates of its frequency were between 10% and 40% [16–18]. In more recent studies these numbers have not dramatically changed, but newer concepts in the spectrum of alterations of glucose metabolism such as impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) have changed the way that glucose metabolism is categorized. According to newer data in larger series (n ≥ 500 patients) the prevalence of manifest diabetes mellitus ranges from 15.8% to 37.6% [19–23]. Overall, these five studies comprise 8,480 acromegaly patients of which 2,014 had diabetes mellitus (23.8%). Other studies investigating smaller cohorts yield approximately the same results [24–31]. A few of these studies also assessed prediabetes, which is IFG and IGT [21,24,26,29–31]. According to these, IFG is found in 7.6% to 19.0% of acromegaly patients. IGT is slightly more prevalent and covers a broader range of 6.2% to 31.6%. Inversely, in those studies that provide data on normoglycemia, the percentage of patients with normal glucose tolerance revolves around 21.7% to 61.4%. Essentially, diabetic and prediabetic conditions are an important comorbidity of GH secreting pituitary adenomas [32,33].
Effect of omalizumab use on glucose homeostasis in non-diabetic patients with chronic urticaria
Published in Cutaneous and Ocular Toxicology, 2020
Tugba Falay Gur, Sevil Savas Erdogan, Vefa Aslı Erdemir, Bilal Doğan
In this study, we examined the changes in fasting blood sugar, insulin and insulin resistance in a patient population without diabetes mellitus or insulin resistance and who were started on omalizumab due to chronic spontaneous urticaria. In these patients, fasting blood glucose and insulin resistance were increased in the 12th week of treatment. At the end of the treatment, 10 patients had impaired fasting glucose and 13 patients had insulin resistance. There was no medication use that could disrupt glycaemic control. In addition, no significant changes were observed in waist circumference, blood cholesterol and triglyceride values after treatment. Therefore, we consider that the increase in fasting blood sugar and insulin resistance may have been caused by omalizumab.
Arterial hypertension and diastolic blood pressure associate with aortic stenosis
Published in Scandinavian Cardiovascular Journal, 2019
Johan Ljungberg, Bengt Johansson, Karl Gunnar Engström, Margareta Norberg, Ingvar A. Bergdahl, Stefan Söderberg
An oral glucose tolerance test, including measurements of fasting and post-load glucose levels, was routinely performed in the VIP, was performed in 60% of MONICA participants, and was not performed in the MSP. Diabetes presence was determined based on self-reported usage of anti-diabetic medication, fasting plasma glucose levels ≥ 7.0 mmol/L, and/or post-load plasma glucose levels ≥ 11.1 mmol/L (≥12.2 mmol/L based on capillary plasma in the VIP). Impaired fasting glucose was defined as a fasting glucose level of ≥6.1 and <7.0 mmol/L. Impaired glucose tolerance was defined as a post-load glucose level of ≥7.8 and <11.1 (≥8.9 and <12.2 in the VIP) combined with a non-diabetic fasting glucose level.
Related Knowledge Centers
- Diabetes
- Hyperglycemia
- Metabolic Syndrome
- Type 2 Diabetes
- Insulin Resistance
- Prediabetes
- Blood Sugar Level
- Fasting
- Glucose Tolerance Test
- Signs & Symptoms